Working mostly in the healthcare sector, an Eligibility Counselor undertakes the crucial role of checking if the applicant is eligible for the programs or medical services or not. While the duties vary based on the needs of the facility, the following are certain core tasks mentioned on a professional Eligibility Counselor Resume – assessing participants and determining the family level of need and priority for in-depth case management services, maintaining the flow of forms to designated sources, providing excellent customer to all served, achieving an acceptable level of computer proficiency, and guiding the applicants to other benefit programs based on their eligibility factors.
Employers typically look for applicants with the following skills and abilities – excellent customer service skills, computer skills, knowledge of HIPAA and EMTALA, knowledge about government resource information and referral procedures for staff to use; and skilled in the use of keyboard and MS products/format. A bachelor’s degree in healthcare or a relevant field is preferred. Experience with case management or casework will be an added advantage.
Headline : To employ myself with a corporation that has an atmosphere of unity, true partnership and on who will afford me the opportunity to contribute my knowledge and skills to their company. Enthusiastic, committed, and willing to assume responsibility, extremely dependable to comply with policies and procedures.
Skills : Microsoft Office, Healthcare, Customer Service.
Description :
Trained new counselors and provided mentoring.
Assisted others when needed to reach deadlines.
Processed applications for State of Michigan medical programs based on the Federal Affordable Care Act (ACA).
Adapted as needed to changes due to introduction of ACA marketplace.
Checked that application data was current and complete.
Contacted clients to resolve application discrepancies.
Analyzed and entered selected confidential data (60%), achieving 99% accuracy.
Experience
5-7 Years
Level
Junior
Education
Bachelor's
Eligibility Counselor Resume
Objective : Qualified by 4+ years of success in Customer Service/Call Center environments, 2+ years of knowledge of CMS & Medicare/Medicaid reimbursement procedures. Passionate about building lasting customer relationships and maximizing quality. Proficient computer skills with excellent working knowledge of Microsoft Excel, Power Point, Microsoft Word and Outlook.
Skills : Sales and Marketing, Customer Service, Persuasion, Negotiations, Complex Problem Solving, Time Management, Creative Problem Solving, Business Development and Computer Proficient.
Description :
Demonstrated the ability to effectively coordinate and supervise assigned shift, utilized equipment, materials, people and support services, so that the call center met its objectives in an efficient manner while achieving customer's quality expectations.
Assisted management with training, troubleshooting, evaluating, counseling; motivating and coaching employees.
Researched and analyzed cases for employees in the queue to ensure policies, procedures and state and federal regulations were met.
Performed other duties as required.
Served as liaison and contact person for coordinating details of cases with clients, management, outside resources, other state and federal agencies, and others involved in the client's case.
Interviewed applicants to determine needed social services such as Food stamps, Medicaid, Families First, and other available services.
Asked applicants questions needed to complete budget forms related to their eligibility status; listened to information applicants provided concerning their eligibility; and, responded to concerns expressed by angry and volatile applicants on matters concerning their eligibility, utilizing case management techniques.
Experience
2-5 Years
Level
Executive
Education
GED
Eligibility Counselor Resume
Objective : To acquire an Eligibility Counselor position that will allow me to utilize my work, educational and personal skills by contributing to the company's growth and success.
Skills : Microsoft Office, Quickbooks, A/P, A/R.
Description :
Responsible for interviewing candidates, processing/documenting information, along with determining eligibility for socio-economic benefits for the Department of Human Services.
Impeccable able to multitask and methodically maneuver various systems, databases, and other sources to verify and support applicant information as well as resolve general customer concerns regarding agency programs, policies, procedures and benefit availability.
Able to work well with others as well as an individual.
Maintained direct support to customers/employees onsite and in other field offices.
Prioritized and organized daily, weekly, and monthly activities to ensure all work is completed by the established deadlines.
Determined benefit eligibility budgets.
Calculated and ensured accurateness of benefits by use of Accent and TN3270 programs.
Experience
2-5 Years
Level
Executive
Education
Business Management
Eligibility Counselor Resume
Objective : As an Eligibility Counselor, Responsible for sending members the Authorized Representative AOA form and a release of Medicaid information form, obtaining the member's Medicare, and also Answering Inbound and outbound calls Assist members with the recertification process for the Medicare Savings Program whether The member applied on.
Skills : Team Member, Counselor.
Description :
Served as direct point of contact for persons seeking state healthcare benefits Acted as a 3rd party mediator by assisting clients receiving State benefits in a high-volume call center.
Provided understandable explanations to customers' inquire about their State-issued benefits.
Handled an extensive amount of inbound calls.
Filed customer appeals formulated through telephone interactions and other methods of contact.
Provided timely and accurate solutions to customer inquiries.
Responsible for confidential data management.
Entered and processed a variety of information, including detailed case notes and other relevant information.
Experience
2-5 Years
Level
Junior
Education
Master Of Business Administration
Eligibility Counselor Resume
Headline : Seek Eligibility Counselor positions with a growth Oriented Company leading to opportunities for increasing responsibility and advancement, where my skills and experience will be effectively utilized.
Skills : MS Office, Reading Skills.
Description :
Contacted members who need to re-certify and are eligible for the Medicare Savings Programs.
Insured that applications are completely filled out and every question is answered correctly before the member submits it to the state.
Followed up to ensure state renewal applications are sent to the state in a timely manner and SSC documents are received to conduct further assistance.
Maintained current knowledge of state and federal regulatory requirements to adhere to strict compliance of all aspects of SSC's Outreach Operations.
Met daily, weekly, and monthly production goals.
Established relationships with clients to enable them to better understand their situations and/or loss of benefits.
Handled confidential information with good judgment and discretion.
Experience
5-7 Years
Level
Junior
Education
MS
Eligibility Counselor Resume
Objective : To establish a long-term career in a company where I may utilize my Eligibility Counselor professional skills and knowledge to be an effective Associate Program Manager and inspiration to those around me.
Skills : Team Work, Detail-Oriented.
Description :
Verified information such as, citizenship, income, residence, and age by making collateral contacts and reviewing documentary evidence.
Documents required verifications, services and benefits provided, and other case-related activity using a computerized case record.
Applied policy, procedure, rules, and regulations governing the determination of eligibility for benefits; and, made decisions regarding the implementation of policy and procedure.
Adhered to HIPAA standards.
Determined status of applications received from ACA Marketplace and posted decisions in State database.
Performed all work duties while multitasking between client phone calls, DHR paperwork, and drop-in clients.
Interviewed applicants to determine needed social services.
Experience
2-5 Years
Level
Junior
Education
MS
Eligibility Counselor Resume
Objective : As an Eligibility Counselor, responsible for Conducting telephonic outreach activities for members who need to recertify and are eligible for the Medicare Savings Programs, contacting the state to properly complete the recertification process, and to verify case status.
Skills : Medical Terminology, Appointment Scheduling, Computer Skills.
Description :
Determined benefit eligibility budgets; calculated and ensured accurateness of benefits by use of the computer system.
Evaluated customers' self-sufficiency and complianced with program requirements.
Referred customers to supportive services, education, and work-related activities; identified relevant services and community resources based on the client's needs.
Responded to concerns expressed by angry and volatile applicants on matters concerning their eligibility.
Reviewed and processed families' welfare while providing information for employment activities, child care assistance and other support services.
Worked with families to develop services such as in-home counseling, mentoring, tutoring and respite for troubled teenagers.
Carried on-call responsibilities monthly on a rotating basis.
Experience
2-5 Years
Level
Executive
Education
MS
Eligibility Counselor Resume
Objective : Seeking a company where I can use my experience and education to help the company meet and surpass its goals. I am motivated with strong organizational and prioritization abilities.
Skills : Edcuator, School Bus Driver, Social Work.
Description :
Used State and Federal guidelines to determine eligibility for the medical program.
Responsible for maintaining changes on cases, such as address changes, household changes and program changes.
Received and screened applications, followed up with customers to gather any missing information.
Displayed excellent communication skills, and an understanding of human behavior to establish an atmosphere in which all contacts with the agency are positive.
Interacted with program participants on a regular, daily basis Educate customers on basic program services and eligibility requirements Work with customers to meet and achieve program goals and/or maintain program services and eligibility.
Processed family applicants to determine eligibility for TennCare/Medicaid benefits.
Interviewed clients to determine eligibility for food stamps and Families First program, maintained caseload of clients, and ensured all criteria.
Experience
2-5 Years
Level
Junior
Education
BA
Eligibility Counselor Resume
Headline : To attain an Eligibility Counselor position where I can utilize my skills I have gained while working or in school. Exceptional Customer Service skills; gained while working in the Banking industry, Human Resources and Medical field. Maintaining a high level of professionalism, patience and efficiency to minimize customer dissatisfaction and increase customer loyalty.
Skills : Word Processing, Data Entry,Multi-line Phone, Copy And Fax Machine.
Description :
Interviewed and determined eligibility for childcare services according to the agency regulations, policies and guidelines.
Recorded and entered data into data base provided by The Department of Human Resource (DHR worker).
Verified client's employment, school information and completing all needed paperwork for file to maintain case management.
Responded to telephone calls, mail or in-person conversations regarding status of eligibility changes and take appropriate action.
Completed and mailed all correspondence to all necessary parties.
Added clients to waiting list as needed.
Processed all paperwork in a timely matter.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Arts
Eligibility Counselor Resume
Summary : Responsible for Conducting telephonic outreach to AL and MI members when their renewal application is received by the Government Relations department, Informing members the application will be sent to their physical address via mail (overnight), Must also providing instructions on how to complete the process.
Skills : MS Office, Documentation Skills.
Description :
Entered applications through computer program (CCMS) provided by the State of Alabama and determined parents' eligibility for waiting list and cases authorized through DHR.
Interviewed clients in-person, biannually as they reapplied for services; requested written documentation to support their need for subsidized childcare.
Used this documentation, along with policies dictated by the State of Alabama, to determine if parents were eligible to continue these services.
Maintained all client files with required documentation and filed for storage on regular basis.
Assisted in front desk duties: answered multi-line phone system, assisted inquiries from walk-in clients.
Maintained and updated hard copies for all client records.
Used fax machine and copy machine on regular basis.
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